In Accelerated Experiential Dynamic Psychotherapy (AEDP), Dr. Diana Fosha demonstrates her healing-centered treatment approach, which aims to capitalize on the client's natural, adaptive, wired-in capacities for healing and transformation. AEDP integrates experiential and relational elements within an affect-centered psychodynamic framework, with the somatic experience of affect in relationship and the moment-to-moment regulation of this experience as the focus of clinical aims to bring about change.

In this session, Dr. Fosha works with a young woman who comes to treatment for help with an unsatisfying marriage. The client is worried that her 3-year-old daughter is being harmed by watching the conflict between the parents. Working to rapidly overcome the client's defenses and fear of emotional closeness, Dr. Fosha helps the client experience and process her deep grief, hurt, and sadness over her own early experiences of being parented. The client experiences a healing transformation and thus accesses confidence in herself and in her own resources.

Approach

A model of therapy needs to be at its essence a model of change (Fosha, 2000b). Accelerated Experiential Dynamic Psychotherapy (AEDP)—a model that integrates experiential and relational elements within an affect-centered psychodynamic framework and places the somatic experience of affect in relationship and its dyadic regulation at the center of how it clinically aims to bring about change (Fosha, 2000a)—is rooted firmly in transformational studies, fields of endeavor devoted to investigating naturally occurring progressive transformational processes that operate powerfully, and often rapidly and dramatically yielding substantive changes that are often lasting.

With its focus on facilitating healing, emotional transformations within an emotionally engaged therapeutic relationship, AEDP seamlessly integrates both previously disparate theoretical constructs and previously disparate clinical strategies of intervention. AEDP's fundamental assumption that change can, and does, take place reliably in therapy is informed by an understanding of the nongradual nature of affective change processes (Fosha, 2000b, 2002, 2004).

The AEDP therapist seeks to catalyze a state transformation of the patient's emotional experience and harness the healing power of emotions. The key to achieving this goal is forming an affect-regulating attachment bond between the patient and therapist from the beginning.

The evidence from these fields points to affective processes experienced within the context of an affirming relationship as being central in such quantum transformations. Efforts to systematically activate these affective change processes in treatment so that their transformational powers can be harnessed to actively foster therapeutic change have guided the development of AEDP and have led to its being fundamentally healing-oriented in theory, metatherapeutics, and clinical practice, and experiential in technique. It is precisely these roots in transformational studies rather than in pathology-based theories that distinguish AEDP from other short- and long-term psychodynamic approaches.

The attachment-based stance of the AEDP model aims to develop a sense of security that will allow the patient, together with the therapist, to take the risk of exploring previously feared-to-be-unbearable emotional experiences. Key to AEDP's understanding of psychopathology is that it develops as the result of the individual's aloneness in the face of overwhelming emotions. Thus, the goal of the treatment is for patients to not be alone with these emotional experiences if they are to be regulated and processed to completion. If within the safety of the therapeutic relationship, they can be experienced, processed, and followed through to completion, the adaptive power, resilience and resources inherent within these emotional processes can be released and the patient's access to them can be (re)established.

There are five other aspects of AEDP to highlight in this summary:

(1) AEDP's therapeutic ethos is to work with the self-at-worst (the patient's self as reflected in the maladaptive patterns of his or her functioning) from the aegis of the self-at-best (the patient at his or her most resourced and resilient). We proceed from strength and health to deal with suffering and dysfunction.

Thus, AEDP features two agents of change: (a) activating the potential for health, healing, self-regulation, and self-righting operating in each and every individual (and to this, the therapist's affirming, attachment-based stance is crucial) and (b) dealing with psychopathology, aiming to reverse the processes that led to the psychopathology and helping restore affective and relational processes to their natural pathways, in which their adaptive action tendencies can come to the forefront and inform the patient's way of engaging in the world as well as his or her inner well-being.

(2) AEDP is a phase-oriented treatment and each phase is defined by the qualitative aspects of the patient's affective experience and the strategies of intervention used are determined by the phase-specific goals of each phase. These phases describe the complete course of the processing of emotional experience (in the context of relational safety) and they apply to both the session and to the therapy as a whole.

(3) The importance of metatherapeutic processing to the consolidation and enhancement of therapeutic effects is a key aspect of AEDP and it brings a unique contribution to the field of psychotherapy. It is a direct consequence of its being a transformation-based, healing-oriented experiential model of treatment. Just as it is important to experientially explore and process through to completion all aspects of the patient's emotional experience, it is equally important to experientially explore and process through to completion the patient's experience of his or her transformation and healing with the therapy process. By focusing on the experience of transformation itself, a fortiori, transformation in the context of a relationship with an affirming, emotionally engaged other, another whole transformation process is activated, which only deepens and solidifies the patient's healing and well-being

(4) The entire experiential aspect of AEDP involves the moment-to-moment tracking of fluctuations in affective experience of the patient, the therapist, and the dyad.

(5) The experiential process that characterizes AEDP involves alternating waves of experience and reflection. This way we are alternately engaging right-brain-mediated and left-brain-mediated processes and promoting their integration, with integration of these aspects of psychological experience being the foundation of mental health.

Several documents follow that elaborate some of the concepts introduced above.

What is Accelerated Experiential Dynamic Psychotherapy (AEDP)?

The function of a model is to tell us where to focus and why, what to aim for in the clinical encounter, and then how to make it happen. In the AEDP model, AEDP metapsychology and metatherapeutics inform clinical work.

Metapsychology

As a theory, AEDP seeks to explain the quantum transformational nature of deep somatically based emotional experiencing in the context of a relationship with a trusted, "true other." AEDP's metapsychology is an adaptation-based model informed by attachment theory, affective neuroscience, developmental mother–infant interaction studies, and emotion theory (e.g., the works of Darwin, Tomkins, Damasio, Ekman, & co.).

AEDP emphasizes the quantum nature of change and specifically identifies positive affects as wired-in agents, markers, and sequelae of that quantum transformation. (There is an entire phenomenology of positive affects—e.g., relational [the "we"] affects, transformational affects, healing affects, core state—that has been developed within AEDP, and it is still unfolding as we keep exploring).

In keeping with its (biological/evolutionary) adaptation-based metapsychology (attachment theory and emotion theory fit right in—it is how we are wired after all), the AEDP model understands psychopathology as reflecting the patient's "best efforts" at adaptation in a maladaptive, skewed environment. Thus, unlike a punitive-superego-based metapsychology where the self-destructive motivational vector has to be reversed, the patient's motivational vector does not have to be changed. The adaptive intentions underlying even the most disturbed presentations have to be affirmed while the patient processes the need to change strategies that were adaptive once, but are no longer; that were once "best efforts" given minimal resources (i.e., being a child, being helpless in a traumatic situation), whereas many more resources are available now.

Metatherapeutics

AEDP's theory of treatment is healing-oriented. Rather than being informed by an understanding of what creates psychopathology, AEDP's model of treatment is informed by an understanding of transformational studies, a field devoted to elucidating the dynamics and phenomenology of healing transformational processes that are at work naturally and in change-based systems.

To harness healing power in treatment, the AEDP model seeks to learn from the naturalistic, healing, positive, transformational-affective change processes that are at work in emotion, attachment, optimal mother–child interactions, and in the body's self-righting tendencies. Specifically reflected in its therapeutic stance, AEDP has sought to learn the lessons of good-enough (i.e., security-engendering) mothers and their good-enough (i.e., securely attached, resilient) babies, thus being open to learning many lessons from good-enough Mother Nature. The explosion of knowledge about how the brain processes and is organized by experiences of emotion and attachment roots AEDP's explorations in the developing field of affective neuroscience.

Treatment

AEDP treatment features a) a therapeutic stance that is affirming, empathic, emotionally engaged, mutual (though not necessarily symmetrical), and affect-regulating and b) therapeutic techniques (relational, experiential/affective, integrative) that rely on the moment-to-moment tracking of somatically based affective experience. This therapeutic stance, optimally suited for the dyadic affect regulation that is central to AEDP, aims to foster the emergence of a securely attached patient–therapist relationship and the techniques aim to facilitate access to adaptive emotional responses.

The aim of the treatment is for the patient to have an experience, a new experience, and that the experience be good. Understanding psychopathology as the result of the individual's unwilled and unwanted aloneness in the face of overwhelming emotions, the therapist seeks to be there, with the patient. The patient is not alone with painful, frightening emotions.

Viscerally experiencing previously feared-to-be-unbearable emotions in the context of an emotionally engaged relationship with a trusted other, and being able to process them to completion until their adaptive action tendencies are released, is the central agent of change in AEDP. Patients thus (re)gain access to their resources and resilience, previously locked away with the unwanted experiences.

Finally, another central and original aspect of AEDP is the focus on the experience of transformation—particularly the experience of the transformation of the self within in an emotionally connected relationship with a true other—as a healing transformational process.

Typical Client

The typical client with whom AEDP has shown to be highly affective is someone who has (a) a history of trauma or loss, (b) an ability to function, despite his or her considerable difficulties, and (c) some capacity for reflection. Often, through a crisis (such as loss of a loved one, job difficulties, or relationship problems) and the desperation, helplessness, and unhappiness that the crisis brings to the forefront, such people become aware of what they are missing or what is wrong in their lives, which often precipitates the person's decision to seek treatment.

The client with whom a 45 to 60-minute single session of work is most likely to illustrate the quintessential aspects of AEDP at work is someone whose problems and difficulties are the result of the overregulation, rather than the underregulation, of an emotional experience. Such a person tends to put others before him- or herself, his or her self-care takes a back seat to taking care of others; and his or her functioning and responsibilities are at the expense of his or her inner life and personal well-being. Typical AEDP clients can be hyperresponsible and have the identity of being "a trooper" or a "caregiver."

Typical scenarios that bring these clients to treatment are impending crisis; threat of loss (because of illness, death, or the deterioration of a relationship); relationship difficulties; being stuck or dissatisfied in a profession; depression; anxiety; a deep sense of something missing or being wrong in one's life; a sense of malaise, futility, meaninglessness, or being ill-at-ease; or knowing about one's problems and problematic patterns and being unable to change. A history of trauma is not to be ruled out, as it is often a significant aspect of these clients' earlier history. Patients with disorders of the self are ideal for AEDP treatment. Contraindicated clients are clients who present with psychotic symptoms, bipolar disorders, endogenous depressions, substance abuse disorders, or impulse disorders.

About the Therapist

Diana Fosha, PhD, the developer of Accelerated Experiential Dynamic Psychotherapy (AEDP) and the director of the AEDP Institute, is the author of The Transforming Power of Affect: A Model for Accelerated Change (2000b) and has written papers on experiential process in dynamic psychotherapy. She also contributed to Healing Trauma: Attachment, Mind, Body and Brain, edited by Marion Solomon and Daniel Siegel (2003).

Dr. Fosha's current work in transformational studies has focused on integrating recent developments in affective neuroscience and developmentally based understandings of the dyadic regulation of affect into clinical work with patients. She is the director of training of the International Experiential Dynamic Therapy Association, serves on the editorial boards of The Journal of Psychotherapy Integration and Constructivism in the Human Sciences, and has done workshops and trainings throughout North America, Europe, and Brazil. Dr. Fosha is also in private practice in New York City.

Fosha, D. (2004). "Nothing that feels bad is ever the last step:" The role of positive emotions in experiential work with difficult emotional experiences. Clinical Psychology and Psychotherapy, 11, 30–43.

Fosha, D. (2004). "Nothing that feels bad is ever the last step:" The role of positive emotions in experiential work with difficult emotional experiences. Clinical Psychology and Psychotherapy, 11, 30–43.

Other recommended references relevant to the work of AEDP

Damasio, A. R. (1999). The feeling of what happens: Body and emotion in the making of consciousness. New York: Harcourt Brace.

Darwin, C. (1965). The expression of emotion in man and animals. Chicago: University of Chicago Press. (Original work published 1872)

Ferenczi, S. (1980). Child analysis in the analysis of adults. In M. Balint (Ed.), E. Mosbacher (Trans.), Final contributions to the problems and methods of psychoanalysis (pp. 126–142). New York: Brunner/Mazel. (Original work published 1931)